19th Annual Developmental Disabilities: An Update for Health Professionals March 5-6, 2020 Dental Care for Children and Adults With DD: Special Considerations Dr. Allen Wong (awong@pacific.edu) � Nothing to Disclose Dr. Allen Wong 2015 (awong@pacific.edu)
Dr. Allen Wong (awong@pacific.edu) - ID/ DD populations, children and adults - Disparity of care overview - Changes in Dental education - Barriers of care - New sciences in dentistry - New strategies for prevention - New materials for dentistry - Prevention and advocacy Dr. Allen Wong 2020 (awong@pacific.edu)
Dr. Allen Wong (awong@pacific.edu) � Picture Dr. Allen Wong 2011 (awong@pacific.edu)
Patients w ith special needs : Those patients whose medical, physical, Psychological, cognitive or social situations make it necessary to consider a wide range of assessment and care options in order to provide dental treatment. These individuals include, but are not limited to, people with developmental disabilities, cognitive impairment, complex medical problems, significant physical limitations, and the vulnerable elderly. CODA 2020 Dr. Allen Wong 2020 (awong@pacific.edu) Generally, an IQ test score of around 70 or as high as 75 indicates a limitation in intellectual functioning. Standardized tests can also determine limitations in adaptive behavior, which comprises three skill types: • Conceptual skills —language and literacy; money, time, and number concepts; and self-direction. • Social skills —interpersonal skills, social responsibility, self- esteem, gullibility, naïveté (i.e., wariness), social problem solving, and the ability to follow rules/obey laws and to avoid being victimized. • Practical skills —activities of daily living (personal care), occupational skills, healthcare, travel/transportation, schedules/routines, safety, use of money, use of the telephone.
(awong@pacific.edu) 2015 Dr. Allen Wong
Fragile X Fetal Down Syndrome Stroke Syndrome Neurodevelopmental Disorder Cerebral Autism ID Palsy Dr. Allen Wong 2015 (awong@pacific.edu)
� # 1 unmet healthcare need for those with special needs - * Dr Rick Rader study 5y ago Dr. Allen Wong (awong@pacific.edu) � General public ◦ Believes people with ID receive better health care than the general population. � Training of Health Care Professionals ◦ 52% of medical school deans, 53% of dental school deans, 56% of students and 32% of medical residency program directors responded that graduates were “not competent” in treating people with ID.
PREDOCTORAL � � 2 -2 3 Graduates m ust be competent in providing oral health care within the scope of general dentistry to patients in all stages of life. � � 2 -2 5 Graduates m ust be competent in assessing ( and managing ) the treatment needs of patients with special needs. Dr. Allen Wong (awong@pacific.edu) PREDOCTORAL I ntent: � � An appropriate patient pool should be available to provide experiences that may include patients whose medical, physical, psychological, or social situations make it necessary to consider a wide range of assessment and care options. Dr. Allen Wong (awong@pacific.edu)
� The assessment should emphasize the importance of non-dental considerations. These individuals include, but are not limited to, people with developmental disabilities, cognitive impairment, complex medical problems, significant physical limitations, and the vulnerable elderly. Dr. Allen Wong (awong@pacific.edu) � Clinical instruction and experience with the patients with special needs should include instruction in proper communication techniques and assessing the treatment needs compatible with the special need. Dr. Allen Wong (awong@pacific.edu)
� Standard 2-1 Curriculum Content � b) Assess, diagnose and plan for the Provision of multidisciplinary oral health care for a wide variety of patients including Patients with special needs Dr. Allen Wong (awong@pacific.edu) � Biases � Diagnostic Overshadowing � Medication changes ◦ - B12 levels ◦ - Calcium ◦ - Magnesium ◦ + Constipation ◦ + Osteoporosis ◦ + Pneumonia Dr. Allen Wong (awong@pacific.edu)
Diagnostic Overshadowing - Blaming a new medical or behavioral problem entirely on an existing disability, for Behavior Behavior example: Complaint Complaint • New behaviors are just due to autism • Decline in mental function is just due to Down syndrome • Decline in physical function is just due to Cerebral Palsy � 1.5% Profound � 3.5% Severe � 10% Moderate � 85% Mild Dr. Allen Wong (awong@pacific.edu)
� Pandemic disease � Preventable disease � Infectious like disease � Multifactorial disease Dr. Allen Wong (awong@pacific.edu) � CA ries � Management � By � Risk � Assessment Dr. Allen Wong 2015 (awong@pacific.edu)
Dr. Allen Wong (awong@pacific.edu) Dr. Allen Wong (awong@pacific.edu)
It’s for Everyone… who has teeth Dr. Allen Wong (awong@pacific.edu) � New Concept… why now? � Old Dental philosophy � Consistency… in material taught.. � Some common questions � Why didn’t my other dentist mention? � I can’t afford that kind of care � My insurance doesn’t pay for it, I don’t want it � I never had problems before with caries Dr. Allen Wong (awong@pacific.edu)
Dr. Allen Wong (awong@pacific.edu) Blood Pressure Blood Test Insulin test C-reactive protein Urinalysis Temperature Dr. Allen Wong (awong@pacific.edu)
Or an idea of Prognosis? Dr. Allen Wong (awong@pacific.edu) � Which is NOT a Pattern Recognition of Dental Caries Risk? Dr. Allen Wong 2015 (awong@pacific.edu)
Pattern Recognition Dr. Kim Kutsch Dr. Allen Wong 2010 (awong@pacific.edu)
25% more likely to get a prescription 300% more likely to continue a prescription 46% of psychotropic drugs don’t have a corresponding psychiatric diagnosis 13% of anti-seizure drugs don’t have a corresponding seizure diagnosis � Major Health Risk Categories ◦ Long QT Syndrome (cardiac arrhythmia) ◦ Weight Gain ◦ Osteoporosis (low bone density) ◦ Constipation ◦ Sun Sensitivity ◦ Reflux ◦ Caries (dental cavities) ◦ Dehydration
������� ������������������������������������������� ������������ Dr. Kim Kutsch ��������� ����� � � Dr. Kim Kutsch
����� ���������������������������������������� ������������������������������������ � -Cravings -Cavities -Obesity -Diabetes -Allergy Dr. Kim Kutsch ��������� ������������������������������������������������������ ��������������������������������������������� Dr. Kim Kutsch
The most significant areas identified to date to have a suspected oral systemic connection are: � Cardiovascular Disease (CAD and Stroke) � Poor Pregnancy Outcomes (Fetal Development, low birth wt, pre-term births) � Diabetes � Bacterial pneumonia (VAP) � Orthopedic Implant Failure � Kidney Disease Dr. Allen Wong (awong@pacific.edu) Young et al., 2011
Picture � Which is NOT a Factor for Caries Risk Assessment Diagnosis? � A) Disease Indicators � B) Socioeconomics Factors � C) Biologic Factors � D) Protective Factors � E) Salivary pH Dr. Allen Wong 2015 (awong@pacific.edu)
A Statistically Validated Caries Risk Assessm ent Form ( 1 3 ,0 0 0 patients) J CA Dent Assn. Oct 2 0 0 7 , p 62 62 7 0 4 9% 50% 77% 88% 100% 100% Young DA, Novy BB, Zeller GG, et al. The American Dental Association Caries Classification System for Clinical Practice: A report of the American Dental Association Council on Scientific Affairs. J Am Dent Assoc 2015; 146(2): 79-86.
� Prevention, prevention, prevention � Evaluate hard tissue (teeth) , soft tissue (gums) and saliva @ baseline � Monitor hard tissue, soft tissue and saliva for changes � Follow prescriptions to counteract effects of disease and medications � Even MD’s can Fluoride Varnish? (USPSTF) Dr. Allen Wong (awong@pacific.edu) Introduction & Science What is Dental Caries: The New Paradigm Environment is Everything y g Dr. Allen Wong (awong@pacific.edu)
CAMBRA: The New Dental Caries Paradigm Dr. Allen Wong (awong@pacific.edu) Young et al., 2011
Caries Treatment Strategies � Restorative plan � Antimicrobial Strategies: CHX, PI, Fluoride, Sodium Hypochlorite � Remineralization Strategies: Fluoride, ACP-CCP or nano HA � Bacteriostatic/ Probiotic Strategies: Xylitol � pH Strategies: Neutralizing and buffering rinses, sprays, gels, toothpastes, baking soda rinses � Behavior Modification: Counsel specific risk factors Dr. Allen Wong (awong@pacific.edu) � Think A, B, C’s Dr. Allen Wong (awong@pacific.edu)
Caries Risk Assessment Risk Factors Visible Plaque Inadequate saliva flow Hyposalivary Medications Acidic Beverages Frequent Snacking (1-3 times daily) Appliances present Deep Pits and Fissures
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